Individual
KATHRYN MASSENGILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
853 N CHURCH ST STE 600, SPARTANBURG, SC 29303-3070
(645) 834-5568
(864) 756-0062
Mailing address
PO BOX 743070, ATLANTA, GA 30374-3070
(864) 560-4304
(864) 560-4413
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1444
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SCG2896162
MEDICARE PIN
SC
Enumeration date
11/11/2009
Last updated
02/05/2021
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